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Predictors of the efficacy of His bundle pacing in patients with a prolonged PR interval: A stratified analysis of the HOPE‐HF randomized controlled trial

医学 射血分数 心脏病学 随机对照试验 心力衰竭 内科学 安慰剂 QRS波群 血流动力学 置信区间 左束支阻滞 束支阻滞 心电图 病理 替代医学
作者
Daniel Keene,Nandita Kaza,Divya Srinivasan,Nadine Ali,Mark Tanner,Paul Foley,Badri Chandrasekaran,Philip Moore,Shaumik Adhya,Norman Qureshi,Amal Muthumala,Rebecca Lane,Christopher A. Rinaldi,Sharad Agarwal,Francisco Leyva,Jonathan M. Behar,Sukh Bassi,G. André Ng,Paul A. Scott,Rachana Prasad,Jon Swinburn,Joseph Tomson,Amarjit Sethi,Jaymin Shah,Phang Boon Lim,Andreas Kyriacou,Dewi E. Thomas,Jenny Chuen,Ravi Kamdar,Prapa Kanagaratnam,Myril Mariveles,Nicholas Johnson,Emanuela Falaschetti,James P. Howard,Ahran Arnold,John G.F. Cleland,Dárrel P. Francis,Zachary Whinnett,Matthew Shun‐Shin
出处
期刊:European Journal of Heart Failure [Elsevier BV]
被引量:2
标识
DOI:10.1002/ejhf.3367
摘要

Abstract Aims The randomized, double‐blind, placebo‐controlled HOPE‐HF trial assessed the benefit of atrio‐ventricular (AV) delay optimization delivered using His bundle pacing. It recruited patients with left ventricular ejection fraction ≤40%, PR interval ≥200 ms, and baseline QRS ≤140 ms or right bundle branch block. Overall, there was no significant increase in peak oxygen uptake (VO 2 max) but there was significant improvement in heart failure specific quality of life. In this pre‐specified secondary analysis, we evaluated the impact of baseline PR interval, echocardiographic E‐A fusion, and the magnitude of acute high‐precision haemodynamic response to pacing, on outcomes. Methods and results All 167 randomized participants underwent measurement of PR interval, acute haemodynamic response at optimized AV delay, and assessment of presence of E‐A fusion. We tested the impact of these baseline parameters using a Bayesian ordinal model on VO 2 max, quality of life and activity measures. There was strong evidence of a beneficial interaction between the baseline acute haemodynamic response and the blinded benefit of pacing for VO 2 (Pr 99.9%), Minnesota Living With Heart Failure (MLWHF) (Pr 99.8%), MLWHF physical limitation score (Pr 98.9%), EQ‐5D visual analogue scale (Pr 99.6%), and exercise time (Pr 99.4%). The baseline PR interval and the presence of baseline E‐A fusion did not have this reliable ability to predict the clinical benefit of pacing over placebo across multiple endpoints. Conclusions In the HOPE‐HF trial, the acute haemodynamic response to pacing reliably identified patients who obtained clinical benefit. Patients with a long PR interval (≥200 ms) and left ventricular impairment who obtained acute haemodynamic improvement with AV‐optimized His bundle pacing were likely to obtain clinical benefit, consistent across multiple endpoints. Importantly, this gradation can be reliably tested for before randomization, but does require high‐precision AV‐optimized haemodynamic assessment to be performed.
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